‫ ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬Original Article ‫ــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬
Use of Stimulant Substances Among University Students in Tehran:
a Qualitative Study
•
Afarin Rahimi-Movaghar, MD, MPH * , Golara Khastoo, MD**
Mahdieh Moinolghorabaei, MD*** , Masud Yunesian, MD, PhD****
Ahmad-Reza Sadeghi, MD*****
P
P
P
P
P
P
P
P
P
(Received: 30 Nov 2010; Revised: 9Apr 2011; Accepted: 13 Jun 2011)
___________________________________________________________________________________________
Objective: There is evidence to show an increase in use of stimulant substances among university students. This
study is a qualitative assessment of the existing situation and the underlying reasons for stimulant use among the
students of Tehran University of Medical Sciences in 2006.
Methods: Three qualitative methods have been used: focus group discussions with 7 groups (60 individuals)
consisting of male and female students in the dormitories and in the university environment, in-depth interview with 20
drug user students, and interview with 20 key informants including counselors, managers and guards of dormitories,
staff of the office for Culture and Welfare Affairs of students and members of students' organizations. Purposeful or
opportunistic method was used for sampling.
Results: Ecstasy and methylphenidate (Ritalin) were mentioned as the stimulants used by the students. The main
declared reasons for ecstasy use were desire to have fun and excitement, desire to modernity, participation in parties,
curiosity and living without family. The high expense of ecstasy pills and the training provided by media were
mentioned as the main protective factors. Most respondents believed that use of methylphenidate was more prevalent
than ecstasy use. In contrary to the drugs used for fun and enjoyment, methylphenidate is used for increasing learning
abilities and academic achievement. Other pointed- out factors were ease of use and being stigma-free.
Conclusion Increasing risk perception via training, social alternatives to risky activities and parental training for
continuing care and advice in the college period are recommended.
Declaration of Interest: None.
Citation: Rahimi-Movaghar A, Khastoo G, Moinolghorabaei M, Yunesian M, Sadeghi AR. Use of stimulant
substances among university students in Tehran; a qualitative study. Iran J Psychiatry Behav Sci 2011; 5(2): 32-42.
Key words: Ecstasy • Iran • Methylphenidate • Stimulants • University Students
Introduction
4TP0F•P4T
S
timulant use is considered as a
global phenomenon. According to
the estimation of UNODC in 2008,
approximately 34 million individuals, namely,
0.6 % of the 15-64- year-old population of the
Authors' affiliation: * Department for Mental Health and Substance
Use Iranian Research Center for HIV/AIDS (IRCHA), Tehran University
of Medical Sciences, Iran. ** Iranian Research Center for HIV/AIDS,
Tehran University of Medical Sciences, Iran. ***Department of
Psychiatry, Tehran University of Medical Sciences, Iran. **** Center
for Environmental Research & School of Public Health, Tehran
University of Medical Sciences, Iran. ***** Tehran University of
Medical Sciences, Iran
•Corresponding author: Afarin Rahimi-Movaghar, MD, MPH,
Associate Professor of Psychiatry, Department for Mental Health and
Substance Use Iranian Research Center for HIV/AIDS (IRCHA),
Tehran University of Medical Sciences, Iran, Imam Khomeini
Hospital, Keshavarz Blvd., Tehran, Iran
Tel : +98 21 66947984
Fax : +98 21 66947984
E-mail: rahimia@sina.tums.ac.ir
32
world has consumed a stimulant during the
most recent year. This rate exceeds the rate of
heroin or cocaine use. More than a half of the
users reside in Asia. Stimulant use has been
controlled in developed countries e.g; the
United States, Canada, Britain, and the
Western Europe countries while the rate is on
the rise in developing countries, especially the
Middle East (1).
3, 4-methylene- dioxy- metamphetamine
(MDMA or Ecstasy) is a hallucinogen
stimulant derived from amphetamine. This
substance has been subject to the attention of
the adolescents and the youngsters during the
recent years. For years the use ecstasy was
considered harmless; but today the extensive
conducted research has shed light on its shortand long- term adverse effects. Some of the
Iran J Psychiatry Behav Sci, Volume 5, Number2, Autumn and Winter 2011
Stimulant Use in College Students
acute adverse effects of ecstasy include
restlessness, anxiety, hyperthermia, hyponatremia,
and brain edema. Use of MDMA causes a
rocketing rise in the frequency of high-risk
behavior and the consumers become accidentprone. On the other hand, the existing
impurities of the substance can be counted as
an underlying cause for hepatic and cardiac
complications. The long-term adverse effects
resulting from a decline in serotonergic
activity include
memory impairment,
impaired judgment, lack of impulse control,
and disrupted sleep- wake cycles (2-5).
Methylphenidate (MP) is an amphetamine
derivative and is mainly prescribed for the
purpose of treatment of hyperactivity disorder
in children or treatment- resistant depressive
disorders. It is abused by some youngsters
with the aim of increasing concentration.
There are some brand names of MP mostly
Ritalin® and Stimdate® in Iran.
While the Netherlands is the first main
production site for ecstasy; Belgium and
Germany stand in the second place.
Nevertheless, it is produced in other European
countries as well as South- East Asia. It is
estimated that 8 million capita have used
ecstasy all over the world during the most
recent year. The highest rate is reported from
the East and South- East Asia while Europe,
Australia, and the United States are reported
to be the next consumption sites. The annual
production rate is estimated to be 100-125
tones. Attention should be drawn to the fact
that all over the world, ecstasy is abused by
the youngsters attending dance clubs who use
the substance for fun (6).
In any community, university students
represent the well- educated class, and their
mental health status can be deemed as a
representative of the future landscape of the
society. This group lies among the very
important groups in assessment of substancerelated issues; to the extent that it is called
“Monitoring the Future” group in the United
States. Evidence provided in different areas of
the world depicts the fact that ecstasy use is
more prevalent among university students.
Majority of the youngsters go through their
first experience of independent life as they
find their way to university; they step into the
new culture and the norms of their comrades
and form their own new social norms (7).
Consequently, a more detailed knowledge of
their behavior and the factors influencing it is
of paramount importance.
Throughout the past three decades,
substance use has increased in Iran
significantly (8). Lots of studies have been
conducted on university students to assess their
substance use (9); however a comprehensive
search of the existing resources does not
provide any qualitative study on stimulant use
among university students.
This paper presents a part of a more
extensive study, which aims at studying the
status of substance use and abuse, recognition
of the factors contributing to start and
continuation of substance use, rate and routes
of access to substances among students
enrolled in Tehran University of medical
sciences in 2006. The University is the eldest
one in the country, where more than 4000
students are studying in. The ultimate
objective of the study is to provide practical
recommendations for design of substance
abuse prevention interventions for university
students. This paper evaluates the status and
the factors influencing stimulant use including
ecstasy and methylphenidate among students
of Tehran University of Medical Sciences.
Materials and Methods
The present study has been conducted in
Tehran University of Medical Sciences. Three
parallel methods have been utilized: Focus
Group Discussions (FGDs) with different
subgroups of students, in- depth interviews
with drug user students, and interviews with
the key informants.
Focus Group Discussions were conducted
for seven groups of students, which included
60 individuals: two female and two male
student groups residing in university
dormitories participated in FGDs, while three
other focus group discussions (two male and
one female group) took place in the university
environment. The list of the dormitories of the
University was received from the Deputy of
Student Affairs. The deputy did not have
Iran J Psychiatry Behav Sci, Volume 5, Number 2, Autumn and Winter 2011
33
Rahimi-Movaghar A , Khastoo G , Moinolghorabaei M , et al.
access to any information regarding the
pensions where students lived. With respect to
the fact that students residing in private flats
did not welcome the research team inside
their residence, samples of these students
were placed into FGDs along with students
living in Tehran. Overall, the necessity of
conducting two sessions each lasting one hour
and a half with the same participants and the
interference with the time of their lectures and
examinations, conduction of the FGDs was a
difficult task to perform.
In-depth interviews were conducted with
20 drug user students. Several approaches
were used to get access to these students.
These approaches included: requesting university
counseling centers, the managements of
dormitories, installation of advertising sheets
in the faculties and the dormitories of the
university providing the information that
students with any experience of substance use
would receive book coupons in case they made
a telephone contact to provide information
required by the research team. The other
pathway to get access to information was
asking individuals about any history of
substance use in case observations inside the
university and the appearance of the
individual were suggestive of substance use.
Twenty key informants were also selected
to be interviewed. In consultation with the
management of dormitories’ affairs and the
management of student relations, the key
informants were selected. While conducting
other interviews, other key informants were
recognized and introduced to the team. These
mainly included counselors, managers of
students’ affairs, direct managers of the
dormitories, the security guards serving in
different shifts in the dormitories and the
members of students’ organization.
Based on the qualitative nature of the
study, the sample was selected through
opportunistic or purposeful method, and
random sampling was not considered as the
method of choice. The research team tried to
include individuals representing different
groups of the population (considering gender
and the faculty); the same methods were
applied for selection of key informants.
Researcher- structured questionnaires were
34
used for the three groups; the questionnaires
mainly consisted of open questions, which
were accompanied with some semi- structured
questions.
The field work was performed in 2006.
The interviewers’ group consisted of
physicians and psychologists experienced in
drug abuse treatment and were trained on
using the questionnaires. All the interviews
were performed with close supervision of the
main research team members so that data
collection process was homogenous as far as
possible while flexibility was also considered
in the process. The qualitative data provided
by the in-depth interviews and the FGDs were
extracted manually and analyzed through
content analysis method. In the first step, the
completed questionnaires were reviewed by
the research team, and then the key words and
concepts were extracted based on which the
report was classified. Eventually, the
responses were summed up and the results
were analyzed and interpreted.
In order to keep in lines with ethical codes,
the interviews were based on voluntarily
participation and all the participants were
included after informed consent. The
questionnaires did not register the names of
the participants and the research team kept the
completed questionnaires as confidential and
only the sum up of the data was presented in
the reports. It should be noted that due to the
illegal and sensitive nature of the subject of
the study, provision of information by the
participants was accompanied with some
resistance.
Results
Characteristics of the interviewees
The 20 key informants included two
counselors, five managers of students’ affairs
office, seven direct managers of the male and
female university dormitory complexes, four
dormitory security guards working in
different shifts, and two from the students’
association). Twelve (60%) of the key
informants were male and the rest were
female. Their age ranged from 24 to 53 years
(mean=35), and their work experience in
university ranged from two to 30 years
Iran J Psychiatry Behav Sci, Volume 5, Number2, Autumn and Winter 2011
Stimulant Use in College Students
(mean=12). Their education ranged from junior
school to PhD level, with participants holding
a bachelor degree having the highest
frequency. Despite their lower education, the
old security guards were found to be the most
informed interviewees.
Of the 20 substance user students who
were subject to in-depth interviews, 15 (75%)
were male. Their age ranged from 19 to 24
years (mean=21). More than 70% were in
their third or fourth year and the rest (30%)
were in either the first or the second year of
university education. These participants were
from different disciplines of medical university,
namely, dentistry, medicine, pharmacology,
radiology, environmental health, nursing, and
speech therapy. Forty percent were essentially
from Tehran and the rest came from other
districts of the country.
Seven groups of students (including 60
interviewees) were arranged for FGDs. Their
age varied from 19 to 24 (mean=22), and were
studying in 14 different majors at different
levels. Thirty percent were from Tehran while
others came from other districts.
Stimulants
It is essential to notify that when asked
about stimulants, the respondents generally
interpreted “stimulant” as ecstasy among
university students. Since the participants did
not
automatically
recognize
Ritalin
(methylphenidate) as an illegal substance
causing addiction, they were all asked about
methylphenidate specifically and separately.
Prevalence of ecstasy use
About 50% of the key informants, 50%
of the substance user students, and 80% of the
students participating in FGDs declared that
they were unaware of the experience of
ecstasy use among university students.
While the informed key individuals
believed that 5% of the male and 3% of the
female students experienced use of ecstasy or
the “Joy” tablets, majority of the informed
students estimated these figures to be 10 and
5%, respectively. The key informants also
considered 1% of the male and 0.5% of the
female students to be constant users of
ecstasy. Majority of the students believed the
figures were 5 % for the male and 2% for the
female students. Overall, students estimated
higher rates for ecstasy use compared to the
key informants.
Some of substance user students believed
that the use of such substances had become
more frequent during the past one or two
years (years 2004 and 2005). Based on their
report, the prevalence of ecstasy use had
decreased to some extent at the time. One of
the substance user students noted: “Ecstasy
use is more frequently observed among rich
male students from Tehran who are keen on
participating in parties. Up to 10% of this
group might have been through the
experience although there has been a
significant decline in the rate of ecstasy use
as a result of the efforts of the mass media to
raise public awareness on the hazards of the
substance.”
One of the female students participating in
FGDs pointed out: “I had been informed by
friends participating in parties that the rate of
use was higher among girls as compared to
boys, and up to 30% of the girls who showed
up in parties used ecstasy.”
One of the female students participating in
FGDs pointed out: “I had been informed by
friends participating in parties that the rate of
use was higher among girls as compared to
boys, and up to 30% of the girls who showed
up in parties used ecstasy.”
Factors contributing to ecstasy use
Based on the information provided by the
three respondent groups (key informants,
substance user students, and students
participating in FGDs), individual and family
factors contributing to ecstasy use include:
- Tendency to experience joy, having fun,
increase energy and the breezy nature of
ecstasy;
- Curiosity for novel sensory and emotional
experiences;
- Tendency to have adventures and taking
risks;
- The concept of modernity of ecstasy use and
tendency to newfangled behavior;
- Interest in participating in parties and the
availability of the substance in parties;
- Pretending bravery, avoiding counted as
Iran J Psychiatry Behav Sci, Volume 5, Number 2, Autumn and Winter 2011
35
Rahimi-Movaghar A , Khastoo G , Moinolghorabaei M , et al.
-
“coward” by others, especially by the opposite
sex;
Considering prohibited and illegal leisure as
a value;
Unattractive nature of other pastimes;
Having a good economic status;
Lack of control and supervision of the
family, and living with friends as singles.
The most important and frequent
underlying reasons for ecstasy use were
mentioned to be “tendency to experience joy”
and “the concept of modernity of use of the
substance”. One of the substance user
students declared: “Use of the substance is
most frequently seen among kids imitating
rich people as if they belonged to higher
economic class of the society.” Another peer
added: “Ecstasy use is more frequently
observed among students with a better
economic status, especially because of the
positive phase, the freshness feeling, and the
laugh it is followed by; especially by Tehrani
boys who tend to participate in parties.”
The respondents reported the factors
related to the university and the student life
environment as below:
- Arranging weekend parties in homes of
Tehrani students and high prevalence of
ecstasy use in these parties;
- Lack of any odor as compared to alcoholic
beverages, cannabis, and as a result, lower
risks at the time of return to the dormitory;
- Tendency to become a part of a
homogenous group of the university
students in these parties;
- The concept of obscenity of use of other
substances, such as heroin, and considering
ecstasy use a high-class habit among
university students.
It was noted that even some of the female
students tended to over-present their own
experience and were proud of stating their
experience in front of others. Some mentioned
that the use of ecstasy was more prevalent
among students of the majors in which there
was less academic pressure and among those
who had more frequent get-togethers.
The respondents believed that the extrinsic
factors outside the university environment
included:
36
- Changes in the norms, or abnormality of the
lives of the youngsters and consideration of
the newfangled behaviors as behavioral
models;
- Rapid cultural revolutions, liberalism of the
youngsters and their tendency to go through
ANY experience,
- Interaction with other users and considering
them as role models;
- Social pressures resulting to integration of
the individual in the communities where any
behavior is welcome;
- Lack or inadequacy of the appropriate
leisure proportionate to the excitement
needed by youth;
- Attending non- student parties by those who
want to avoid their leisure being disclosed
in the university or the dorm;
- Variety of the substances available in the
market and their accordance with the
adventurous nature of some of the students.
Majority of the respondents believed in the
positive influence of the educational and
awareness- raising programs broadcasted by
the mass media throughout the most recent
year; these programs eventually resulted in a
more cautious attitude. The higher cost of
ecstasy as compared to other substances
available in the market was also highlighted
as a limiting factor. One of the substance user
students mentioned: “I experienced ecstasy
once or twice in the parties of rich people;
either fortunately or unfortunately, I could not
afford it thereafter!”
Based on the viewpoints of the
respondents, the most significant factors in
continuance of ecstasy use included gaining
desirable results from the very first
experiences, e.g.; having more fun and being
invited to subsequent parties. One of the
students noted: “The guys who do not join the
peers in their substance use will never be
invited again.”
Methylphenidate Use
All participants knew and used the term
Ritalin instead of the generic name of
methylphenidate (MP). In this article, we use
the term MP, as other brands of MP might be
used and abused as well. About 50% of the
Iran J Psychiatry Behav Sci, Volume 5, Number2, Autumn and Winter 2011
Stimulant Use in College Students
key informants, 10% of the substance user
students and 30% of the students participating
in FGDs declared their unawareness of the
experience of MP use. Majority of the key
informants believed that the rate of MP use by
students exceeded ecstasy use, to a great
extent.
The most frequent answer about the rate of
MP use among male and female students was
20% and 10%, respectively. Meanwhile, the
rate of constant use of MP was believed to be
5% among males and 2% among females.
Majority of the respondents believed that as
MP was used as a medicine, students did not
find its use as a wrong habit.
Individual factors contributing to MP use
were mentioned as more positive attitude
towards it as compared to other abusive
substances (especially among students of
Medicine), more curiosity around the effects
of its use, academic competition of the
students, and the belief that MP would never
cause dependence.
Respondents believed that the factors
related to the university environment and
student life- style influencing MP use mainly
included its more normality in the students'
culture, which in turn affected individual
beliefs and values. Sometimes even those in
their internship period advised the junior
students to use MP. Lack of objective-oriented
planning, use of MP for enhancement of
learning at the final exams’ season instead of
having a well-structured program for studying
during the trimesters and the greed of the
youth to have an easy student life were
mentioned as other contributing factors.
Majority of the respondents believed that the
rate of MP use increased during the exams’
season. It was also mentioned that the
students of Medicine has easier access to the
substance to the extent that they could provide
it for themselves and their friends. It was
mentioned repeatedly that most of the users
either were studying in one of the medial
majors or had been encouraged to use the
substance by people who had the authority to
prescribe it and this was the main reason for
regarding MP use as a normal behavior.
One of the substance-user students noted:
“Ritalin use is more frequent among senior
students, especially students of Medicine
during exams’ season and their shift nights.
They say it has been prescribed by their
physician. Seven to eight students of the 20032004 have honestly told me in person that
they use Ritalin during the exams’ season.
However, through discussions with friends who
attend other majors such as art and
technology, we are aware that Ritalin use is
even more prevalent among these students; at
least 30% of them use Ritalin.”
Respondents believed that the most
important extrinsic factors regarding MP use
included easy access to the substance, and
lack of recognition of its use as an obscene
habit causing addiction by the public. Majority
of the respondents believed that MP use would
not cause legal problems for the individual.
Discussion
Substance use is a phenomenon leading to
various physical, mental, social and economic
harms, sometimes to the extent that the
individual experiences serious decline in his/her
individual or social function. Substance use is
also considered as a contagious phenomenon,
which endangers the peers and friends of the
substance-user individuals. One study has
depicted the fact that an ecstasy user will only
need 15 months to make half of his/ her
friends to use it (10). Therefore, this fact
requires serious but at the same time scientific
act of the responsible bodies. Evaluation of
the different aspects of the phenomenon is
deemed quite necessary in order to plan an
appropriate response. Qualitative studies can
be considered as one of the steps based on
which future response is planned. Due to their
qualitative nature, these studies can be
counted as the supplement for the quantitative
studies. The possibility of rapid conducting of
such researches, their low costs, and the
extended data provided, the qualitative studies
are considered as effective tools for managers
and program planners. In majority of the
cases, these studies increase both reliability
and validity of the results by means of
multiple data collection methods that is called
triangulation.
In the present qualitative study, majority of
Iran J Psychiatry Behav Sci, Volume 5, Number 2, Autumn and Winter 2011
37
Rahimi-Movaghar A , Khastoo G , Moinolghorabaei M , et al.
the respondents estimated the rate of the
experience of ecstasy among male and female
students to be 5-10% and 3-5%, respectively.
Constant use of ecstasy was reported to be
rare. Even though quantitative studies are the
preferred method for assessing the prevalence
of the phenomena, it is recommended that the
accuracy of self-reports in surveys, regarding
prevalence of substance use are confirmed
through qualitative studies and estimations
provided by the key informants about the
population being studied. Although the
estimations might be influenced by several
biases, but these can be diminished by
including several types of well-informed
groups of respondents, such as the three
groups included in present study.
Throughout the past decade, there has been
a significant increase in the produced and
published science regarding the nature and the
extent of substance use in Iran. In the same
ground, a significant number of epidemiologic
studies have addressed substance use and use
disorders among university students. These
studies have been all reviewed in a systematic
review (9), which provides the summation of
17 studies conducted throughout 1997- 2003.
The systematic review has concluded that
alcohol use must be more prevalent than the
other assessed substances among university
students. Opium and Cannabis ranked second
and third. The review retrieved only three
studies on stimulant use among university
students. In 1999, lifetime prevalence has
been reported to be 0.4 % in female students
in Tehran. In 2001, a study in Mashhad
reported a lifetime prevalence of stimulants
use of 1.4%, and daily use of the substance of
0.2 % without any differentiation for the two
genders. In another study conducted in 15
cities in 2002-2003, the results have not been
reported separately for the two genders,
either. The study reported a lifetime
prevalence of 0.4% of ecstasy use.
Moreover, Iranian researchers have been
more focused on this issue during the most
recent years. A study on lifetime prevalence
of ecstasy use in six universities in Tehran
during the academic year of 2005-2006 it as
0.7% (11). At the same time, the lifetime
prevalence of stimulant use among male
38
university students in Rasht city has been
reported to be 7.25% (12). In 2004, a study on
university students of Birjand city found a
very limited awareness of the students
on ecstasy and a lifetime prevalence of 4.3%
(13). Moreover, some studies have addressed
the young population, not considering
whether the sample members were university
students or not. In 2004, lifetime prevalence
of ecstasy use among youth in the age range
of 15-25 attending the coffee-shops of five
different regions of Tehran was 18.5% (14).
The same indicator was reported to be 7.6%
(15) among the adolescents in the range of 1618 years in the west of Tehran. Another study
including high school students of Lahijan
district in 2005 points out the prevalence of
ecstasy use to be 2.4% (16). In two other
studies the rate of ecstasy use by high school
students of Gonabad and Rasht, was
significantly lower, namely less than 1% (17).
In general, the spectrum of the figures
reported for ecstasy use is quite wide and at
least among university students it ranges from
0.4% to 7.25%. The estimated rates provided
by our study seem to be close to the upper
extreme of this spectrum.
In the United States, assessment of ecstasy
use has been integrated into the national
longitudinal study since 1989. Between 1989
and 1994, ecstasy use had a low prevalence
rate but through 1994 to 1997, the last year
use increased from 0.5% to 2.5%; this
rocketed to 9.2% by 2001. At the point of
2003, there seems to be a turning point since
the direction of the graph reverses and the
prevalence rate declines to 2.2% in 2007.
Researchers link the decline in ecstasy use
with the very extensive education throughout
the mass media and the raised awareness of
the different subgroups of the community
regarding the adverse effects of ecstasy. Such
changes in use of ecstasy have been observed
not only among university students but also
among high school students as well as the
youngsters not attending university (18).
In Britain and Australia, stimulants use
including ecstasy use rank second after
cannabis use among all illegal substances (19,
20). In a study conducted on students of
Medicine in Turkey, 4% reported a history of
Iran J Psychiatry Behav Sci, Volume 5, Number2, Autumn and Winter 2011
Stimulant Use in College Students
illegal substance use in their lifetime. These
substances mainly included cannabis, ecstasy,
and cocaine (21).
In the present qualitative study, which has
been conducted through in-depth interviews,
and FGDs, several factors were considered as
contributors to the use of ecstasy. These
mainly included the breezy nature of ecstasy,
the concept of modernity of use of ecstasy,
participation in parties and living with single
friends, curiosity and tendency to adventures,
lack of any odor of the substance resulting in
secrecy of the use, and lack of obscenity. On
the other hand, the high costs of ecstasy pills
and the education provided through the mass
media have been named as the limiting factors
for its use.
Some of the factors contributing to ecstasy
use have also been evaluated in crosssectional quantitative studies. In one study
conducted in six universities in Tehran,
ecstasy use has been reported to be more
prevalent among students not residing in
dormitories rather than those in dormitories
(11). In the study conducted on male university
students in Rasht city (12) and the study on
university students of Birjand city (13), the
rate of ecstasy use was higher among
university students residing in rental flats as
singles as compared to those residing in
dormitories or living with their parents.
Among the youngsters in the range of 15 to
25 years referring to the coffee shops of five
regions of Tehran, ecstasy use was significantly
correlated with male gender, higher levels of
income of the family, substance abuse and
higher scores in Beck inventory (14). In the
study conducted on a sample of adolescents in
the range of 16 to 18 years in the west of
Tehran, assessment of the correlated factors
showed that almost half of these adolescents
had a medium level of awareness regarding
ecstasy and the adverse consequences of its
use (15). In the study conducted on high school
students of Lahijan district, the results of
logistic regression showed that participation
in peers’ parties, use of other substances and
cigarette smoking were the factors correlated
with ecstasy use. Among individuals
participating in peers’ parties, lifetime
prevalence of ecstasy use was 3.4 times more
prevalent (16).
On the other hand, evaluation of the most
informed university students, namely,
students of medicine in their internship in one
of medical universities of Tehran in 2004
showed that the information of these students
regarding ecstasy was not sufficient; one third
of them were unaware of the potential of the
substance to cause dependence. It might be
interesting to note that only 17% of them had
acquired their information regarding this
substance through university courses (22). The
results of another study conducted on general
physicians of Kerman district illustrated that
the information of a great number of the
participants regarding ecstasy was quite
inadequate (23).
In a qualitative study in the United States
through conduction of FGDs with 30 university
students, majority of the respondents
mentioned the positive effects of ecstasy on
mood, sense of joy, mental changes and
curiosity. They disclosed pressure of friends,
easy access and easy use as the reason for
ecstasy use (24). A cross-sectional quantitative
study on the factors contributing to ecstasy
use by American university students have
illustrated the fact that ecstasy users are less
religious and study less strictly. Meanwhile
these individuals are more sociable, spend
more time with their friends, and have more
interests in arts (7).
Regarding use of MP, majority of the
participants of the present study estimated the
prevalence rate to range between 10 and 20%.
Most of them believed that use of this
substance is more prevalent than ecstasy. In
contrast to the high number of the studies
conducted on substance use by university
students throughout the recent decades in
Iran, we did not encounter any Iranian study
depicting the prevalence of the use of this
substance separately and quantitatively. This
shows that the use of this substance has not
been a subject of interest for Iranian
researchers. The reason might be the fact that
this substance does not considered highly
obscene. The other rational might be the
belief of the researchers themselves that the
substance use is accompanied with low harms
and lacks abusive potentials. UNODC has
Iran J Psychiatry Behav Sci, Volume 5, Number 2, Autumn and Winter 2011
39
Rahimi-Movaghar A , Khastoo G , Moinolghorabaei M , et al.
reported that the prevalence of MP abuse is
only significant in the United States and
Australia (25). A systematic review showed
that based on the 21 studies included in the
review, the prevalence of last year use of MP
among university students in the United
States ranged from 5 to 35%. On the other
hand, 16-29 percent of the university students
with ADHD who had been prescribed MP,
had mentioned a history of the sale of their
medication (26). However, our qualitative
study highlights the need for more studies on
this substance.
The present study also depicts the fact that
in contrast to the other substances, which are
mainly used for the purpose of joy and fun,
MP is mainly used with the purpose of
increased learning capacity and academic
efficacy. Use of MP is accompanied with the
incorrect brisk method of education and study
in universities, namely, increasing memorized
information at exams’ seasons. Use of MP is
not accompanied with the sense of obscenity
of use of other substances; this factor can be
considered as a reinforcer for MP use.
However, this fact is not limited to Iran. In a
study conducted in 2006 in the United States,
in-depth interviews with MP users shed light
on the fact that its use took place mainly at
the time of academic pressure. Decrease of
fatigue, increase of learning abilities, it's easy
and non- stigmatized use were mentioned as
the main reasons for its use (27). Thus, it
seems that the pattern and the contributing
factors for MP use in Iran match the pattern
found in the United States.
Despite the increasing trend of stimulant
use in some parts of the world, especially
Asia, developed countries like the United
States, Canada, and some of the European
countries have succeeded to control and
decrease the rate of stimulant use among their
youngsters. In the United States, the rate of
amphetamines’ use by high school students in
2006 has decreased to a third of the rate
reported in 1997. Decrease of access to the
substances and increase of the sense of harms
lie among the most important reasons for this
decline (18).
Findings illustrate the fact that extensive
and exact information provision regarding the
40
hazards of the stimulants especially ecstasy
and MP which are the most frequently used
stimulants among university students, should
be deemed as an essential requirement. Raising
awareness through information provision
must take place during adolescence and
before stepping into university. Moreover,
considering the influence of social beliefs
especially the norms of the community of
university students, preventive measures
should be based on reinforcement of creative
thinking and social skills of the individuals
so that they become competent to act
appropriately in different settings.
One of the most important findings was the
correlation of the use of these substances with
peers’ parties; a fact that has also been
notified by other studies conducted in other
countries. Access to healthy and attractive
social environments can be a substitute for
risky leisure of the youngsters. It also seems
that the care provided by parents should be
continued in the age of university; supervision
and presence of parents in peers’ parties is
quite essential.
Authors' Contributions
ARM, MMA, MY and ARS designed the
study. GK directed the field work. GK and
ARM performed the analysis and developed
the first draft of the manuscript. All authors
read, revised and approved the final
manuscript.
Acknowledgements
This study has been sponsored by Deputy
of Research of Tehran University of Medical
Sciences based on the contract 132/11885.
The research team would like to express its
appreciation for all of the managers of the
Deputy of Students’ Affairs especially students’
counseling center, management of dormitories’
affairs, management of the dormitories and
management of security who provided the
facilities for this study. The team also
appreciates the very efforts of Dr Hossein
Jabbari, Ms Haleh Safarzadeh, Ms Fereshteh
Bineshpour, Ms Maryam Salehi and Dr
Shahrzad Alizadegan.
Iran J Psychiatry Behav Sci, Volume 5, Number2, Autumn and Winter 2011
Stimulant Use in College Students
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